Dearest:   My guest tonight is Kenneth Blanchard, Ph.D., M.D. 
Dr. Blanchard majored in chemistry at MIT, completed a Ph.D in 
Chemistry at Princeton while teaching for three years at Vassar College. 
While at Vassar,Dr. Blanchard became fascinated by medicine and went on to 
Cornell University Medical College. 

Millions who are properly diagnosed find themselves undergoing 
ineffective treatments for hypothyroidism. In his new book,
What Your Doctor May Not TellYou About Hypothyroidism: A Simple
 Plan for Extraordinary Results, Dr. Blanchard
provides a groundbreaking treatment program drawn on emerging 
research,medical facts, and three decades of clinical experiences 
as an endocrinologist. 

It's an individualized program to help diagnose sufferers 
through symptoms,not lab results- and treats patients of all ages
with the safe, but little used T3 hormone in the best combination 
with the more common T4 hormone,as well as with specific nutritional 
advice and alternative treatments that really work! 

It's a pleasure to welcome you to Power Surge, Dr. Blanchard. 


Kenneth Blanchard, M.D.:   It's a great pleasure to be here. 


Dearest:   As you know, Power Surge is a community for women in menopause. 
I imagine hypothyroidism can be easily overlooked in perimenopausal women,
seeing as how so many of the symptoms common to hypothyroidism, 
weight gain, anxiety, depression, fatigue, hair loss are also very 
common symptoms during perimenopause. Your thoughts?


Kenneth Blanchard, M.D.:   I think that this is generally very true. 
Hypothyroidism is very common.  Doctors have been trained for many years that 
all they need is a blood test and all the women's problems can be related to 
thyroid. I think that has been one of the big mistakes in medicine. 


Dearest:   For years, doctors have used the "TSH" test as the gold 
standard in determining if someone has hypothyroidism, then prescribed the 
standard Synthroid, Levothroid, Levoxyl, et. al. This question has two 
parts. How do your theories regarding testing and diagnosis for 
hypothyroidism differ from conventional methods? 


Kenneth Blanchard, M.D.:   I approach the patient initially like every 
doctor does,taking blood, including TSH.  When TSH is initially high, most 
doctors will agree that there's a problem.  When it's in the normal 
range but everything else points to hypothyroidism I personally have 
disregarded the TSH test since 1985 and that has served my patients 
very well. 


Dearest:   So, secondly, how does your treatment differ from the 
conventional way hypothyroidism is treated?


Kenneth Blanchard, M.D.:   Well, since about 1970 all doctors have 
been taught that patients need T4 instead of T3 which is converted to 
T4 in the body.  In some cases, there are individuals who do reasonably 
well on 100% T4.  I have a few patients on 100% T4.  The only one many 
doctors really know is to try the standard, such as Synthroid.  People 
often feel remarkably well for 3-4 months, then the symptoms come back
Many of the patients who come to me feel terribleon the standard 
treatment.  I know that those patients need T3 added to the T4.  
That's the essence of what I do. 

There have been several studies in the last few months, but 
they use higher proportions of T3 than T4 than I do and the results 
don't come out as they do in my practice.  Since they go above the 
optimum dose of T3, they don't provide the proper results, and the 
studies are useless. 


Dearest:   How successful has your method of treatment been? 
And, why don't more doctors know about this method of treatment? 


Kenneth Blanchard, M.D.:   The treatment is so successful that no 
one has left my practice in the last 5 or so years.  I practice in the 
Mecca of medicine,in Boston, and it's 50 to 1 in my favor that this 
plan works.  My practice is almost completely full. 

There are 2 things.  I am only a practitioner.  What I do has 
evolved gradually over the years.  Usually a doctor will run a study 
which has been published.  
Doctors who publish in journals on textbooks say that my work 
is anecdotal.  Clinical endocrinology says that they gave T3 and
T4 and they didn't work, but they gave the wrong proportions, 
different than mine.  If I wrote to them, they would want to see
a study. 

There's basic conservatism. Doctors are encouraged to not use 
specialists by the HMOs.  Doctors may be afraid to use my method,
in case it doesn't work for them and they're afraid of the 
potential lawsuit.  


Dearest:   So, bottom line, is go to an endocrinologist if you have
any concerns about or HAVE thyroid disease and not to a primary 
care physician at some HMO, yes? 


Kenneth Blanchard, M.D.:   Not really. The endocrinologists all
believe that the TSH is the gold standard. You need to find 
a doctor at a high ranking medical institution. 


JenS:   I have no more thyroid thanks to thyroid nodules and 
Hashimoto's disease. Doc insists on just doing a TSH. What tests 
really should I have? I still feel awful even though TSH is okay.
I also have a pituitary tumor.  I have the symptoms 
of Cushing's but also tons of thyroid problems. He won't run a 
full panel, just TSH! 


Kenneth Blanchard, M.D.:   Well, if there is a pituitary tumor 
that is affecting the thyroid my approach would be to do a
therapeutic medical trial to determine thyroid function. 


KathyB48:   Does taking your temperature, under the arm, for 10 
consecutive days and being under 98.6 degrees mean you have 
hypothyroid? What tests should you get? 


Kenneth Blanchard, M.D.:   This has long been reputed to be the best 
way to check for hypothyroid.  Many patients come to me with a list 
of lower temperatures.
I do believe that this is somewhat useful, unlike some 
professors who go by TSH only.  Expecting that there's going to 
be a yes or no definitive answer is wrong. It all comes down to doing 
a therapeutic trial. 

There are many myths about therapeutic trials.  One is that if 
you take medications, the thyroid will stop producing - completely
false.   Also a therapeutic trial will not produce osteoporosis. 

If a patient tells me several months later that a medicine 
isn't changing anything, then she just goes off the drug and 
there will be no harm done. 


Dearest:   What are the symptoms of hypothyroidism, and is it 
possible to be hypothyroid and symptomatic? 


Kenneth Blanchard, M.D.:   I think that hypothyroidism is a 
functional state. I think if you feel exceptionally well, 
you can't be hypothyroid. 

The symptoms include fatigue, collapsing late in the day, cold 
in the hands and feet, sleep is disrupted, difficult sleep, very 
active in bed - restless leg syndrome. 

Also hair loss, dry skin, constipation, puffiness around the 
eyes, loss of eyebrows.  Many people have been having these 
symptoms but have been told that they can't have any problems 
if the TSH is ok. 

The disorder is more common in women and affects the menstrual 
cycle in many ways such as PMS.  Fatigue, irritability, amenorrhea,
 many PMS-type problems.  All of them can be caused by thyroid 
problems.  A women may be ok but get diarrhea at the
time of her period.  If she sees a gastroenterologist she may 
be told that she has irritable bowel syndrome (IBS).   

Hypothyroidism affects mental processes, and women may become 
depressed, especially in the winter and may be told that she has SAD 
(seasonal affective disorder). Thyroid can mask as that.  Mental 
sharpness can be affected, too. The drugs that are given are 
somewhat helpful, but it is better to correct the hypothyroidism 
than the symptoms. 

I believe that many women have infertility problems. That can 
also be a symptom of hypothyroid, especially in the 30s and 40s. 
If they see an infertility specialist, he will order a TSH test. 
If the woman has tremendous fatigue or the other symptoms, 
it's much better to give her a therapeutic trial of thyroid 
medications than the more expensive, artificial means of getting 
pregnant.  Many of my patients have become pregnant after starting 
my program. 


KathyB48:   I have a lot to the symptoms you mentioned so how 
can we be sure it's hypothyroid? 


Kenneth Blanchard, M.D.:   As I mentioned before, someone has to 
prescribe a therapeutic trial of medication for you. If you get better, 
then you know that you are hypothyroid. You cannot depend on blood 
tests alone. 


Annie:   How do you feel about prescribing sustained T3 only? I 
believe I don't convert T4 to T3 based on all my research, but 
haven't found a doctor to listen to me. I feel like I'm crazy!


Kenneth Blanchard, M.D.:   The important thing in prescribing a 
thyroid hormone is that you have to attain the right T3 in the body.
I don't think that anyone is well served by using T3 only.  Dr. Wilson 
published a book in 1991 called Wilson's Syndrome.  This book is
interesting in that it has many pages of glowing testimonial letters.
The problem is that T3 slowly lowers the balance in the body.  
T4 levels fall slowly in the tissues.  The patient feels better 
for a few months but then they crash. I guarantee that no one can 
take only T3 for very long. 


ShelleyH:   Is it normal for the thyroid to go through changes, 
where it's underactive for a time, then OK, or even overactive 
for a time, then OK?


Kenneth Blanchard, M.D.: People can have transient hyperthyroidism 
which goes away in time.  Some people in later life have been 
shown to change from hyperthyroidism to hypothyroidism.  
Developing hyperthyroidism after a period of 
hypothyroidism for a period is rare. 


Nan:   I have all the symptoms, but normal TSH, T3,T4. Does 
hypothyroidism have any effect on blood pressure, as well? 


Kenneth Blanchard, M.D.:   The effect of hypothyroidism on blood pressure
is complex.  It tends to cause high blood pressure especially 
in a woman's 40s. For younger women, they may feel dizzy.  I have 
seems a number of women in my practice with borderline high blood
 pressure and on proper thyroid treatment.There is no simple 
relationship, however. 


Awoolsock:   Does hypothyroidism ever correct itself without 
use of drugs and are diet and vitamins useful in controlling 
thyroid function? Thanks.


Kenneth Blanchard, M.D.:   I think that in most cases using diet or 
supplements will not correct hypothyroidism.  In very early stages,
 the uses of thyroid-enhancing supplements like iodine might help 
some individuals make enough hormone to solve the problem.  I don't 
think that diet will correct the problem if there are 
significant symptoms. 


Dearest:   Are there any pre-existing conditions that might contribute 
to the onset of hypothyroidism?


Kenneth Blanchard, M.D.:   If you mean medical conditions, I can't 
think of any. Patients with prior radiation to the neck area 
are at a high risk.  The tragedy is that doctors are taught to 
watch out for this, and they run TSH tests. The women
are gaining symptoms but nothing shows on the TSH yet. 


Dearest:   Thank you. How common is hypothyroidism today 
and why are women more at risk than men? 


Kenneth Blanchard, M.D.:   Women are felt to be more at risk because 
most hypothyroid is autoimmune.  All the autoimmune diseases 
are more common in women, like lupus.  It depends on how you define
 hypothyroidism. It's not just the TSH number. 

5-10 million people have hypothyroidism based on TSH.   Those 
numbers are irrelevant because hypothyroidism, to me, means that 
someone comes to me with a lot of symptoms.  If a doctor does a 
therapeutic trial and the patient feels that her
life has changed - that's what defines hypothyroidism to me. 
That might be 40% of the female population who would benefit
from a therapeutic trial.


Nan:   With "normal" test results, how can we convince a doctor 
to look further? what tests should we insist on? 


Kenneth Blanchard, M.D.:   If a patient has a positive test for 
thyroid antibodies,some patients will be treated because a 
few doctors think that the patients are on the way to a thyroid 
problem.  Many doctors won't do that, though,in case of error.


Idelle:   In addition to being hypothyroid (RAI less than 1% 
off thyroid) I now have testosterone 600+ng/dl after a unilateral 
adrenalectomy (macronodular hyperplasia, immunostained 5% focally 
for testosterone secreting cells)I recently had a BSO,
but the testosterone remains high.  My biggest problem is 
anxiety/depression, not hirsutism.  The doctors are running out 
of ways to find the source of the testosterone and I'm not anxious
to have my remaining adrenal removed without more 
evidence that it needs to be done. Conventional scans don't 
show a source and a radioisotope, NP-59 scan DIDN'T show adrenal 
hyperplasia. Any ideas? Particularly for psychiatric medications 
to help? 

The aberrant testosterone seems to be affecting my thyroid 
levels (e.g.low SHBG, suppressed TSH).  Right now I can get my 
free T4 mid-range, but free T3 is probably low unless I add some 
T3 and then my pulse exceeds 80 bpm.  Remeron is sedating,
but doesn't seem to help in any other way.


Kenneth Blanchard, M.D.:   All I can say, at this time of the 
night I'm overwhelmed. That is very complex and difficult to 
address in this medium. 


WayBar:   My doctor tried me on Armour 15 mg. I felt better at 
first, but then felt like I was on too much caffeine, very jumpy 
and nervous. The doctor discontinued the Armour, saying it was
 making me hyperthyroid. Could I still need thyroid? My urine 
is 96 degrees in the A.M., I'm always constipated, I'm tired, 
have dry skin, feel anxious, feel cold when no one else does,
 sparse eyebrows, restless leg syndrome. Thanks.


Kenneth Blanchard, M.D.:   Yes, you do need thyroid.  Armour 
15 mg. is the lowest dose. 


WayBar:   Is there something else I should take with the 
Armour? 


Kenneth Blanchard, M.D.: Armour thyroid by itself is not good for 
the long term because the ratio is not the same as natural body
 ratio.  The initial benefit tends to go away over time.  
It sounds like you have a very low need for medication and 
the Armour has more T3 than you need.  What is needed is to 
give thyroid extract in a time-release capsule, perhaps 1/3 
of the dose.  Since that pill is so small that 
it can't be cut, but it can be compounded to get the right 
amount.  A mixed response like that does not mean that you 
don't need to be on thyroid, but you need the right 
dose.  It sounds that in the beginning you were in your "sweet 
spot" but then you went over your amount. 


BroknWngz:   Can this syndrome also cause thinning hair on the 
head and pubic area as well as eyebrows? 


Kenneth Blanchard, M.D.:   Yes, it can. 


MMM:   1 year ago I was diagnosed with borderline hypothyroid. 
2 months on Synthroid with NO change; 9 months Armour - no change.  
I gradually weaned off Armour. I went to a supplement of Thyroid 
and LTyrosine Complex and essential oils. I feel "a bit" 
better, but will I be in trouble that I just quit Armour? 


Kenneth Blanchard, M.D.:   
That's a very involved question and there are a lot
of issues in therapeutic trials and I can't say much about this 
individual response.


Klee:   I am currently on Armour, 135 mg, DHEA, and Cortef 25mg 
a day. I surgically entered menopause 2 1/2 years ago from ovarian cancer. 
I am experiencing a lot of fluid retention, this is my biggest 
complaint. I tried using the timed release T-3, 
but this did not effect any substantive changes. This edema has 
probably added 20 pounds on me. I work out regularly with no 
success. I am tired and frustrated with all of it. Other than that, 
I function pretty well, all things considered. 


Kenneth Blanchard, M.D.:   I'm sorry that I can't give you a simple answer.  
Fluid retention is telling us that there's something hormonally 
wrong.  I think that few, if any, human beings belong on Armour 135 mg.
 If you came to me, I would give you much less Armour and more T4. 

If you have adrenal insufficiency, the Cortef shouldn't cause 
fluid retention. 

If you are gradually reduced on the Armour and add in T4, I 
would think that the fluid retention would be less.  When
in doubt, correct the thyroid first. The Armour 135 is very high. 


Debrikkia:   Long story short-I had thyroid surgery 25 years 
ago for a mass. It turns out that it was just "cold spots", but 
I was still put on Synthroid for Thyroiditis. This caused me 
to be hyperthyroid and have bug eyes.  The doctor told 
me just to stop the medication.  Since then many doctors have 
questioned this and wonder why I'm not on thyroid medication.
Your thoughts on this?  My thyroid tests ever since have been 
within normal range. I did have radiation therapy back in the 
50's for chronic sore throats. 


Kenneth Blanchard, M.D.:   The short answer is that taking exogenous 
T4 does not cause bug eyes.  That is caused by Grave's disease.  
If the cause of your hyperthyroidism is from medications, the result 
would not be this.  Probably you should be on thyroid, but I believe 
that only a few people will feel well on T4.  Unfortunately, the bug 
eyes won't go away. 


Dearest:   What is the 2% T3 solution you discuss in your book? 


Kenneth Blanchard, M.D.:   The whole thing that has to be accomplished
to make people feel well is to get a good balance.  I have been 
doing this since 1990 and find that people who have 98% T4 and 2% 
T3 have the best ratio.  Armour thyroid by itself is about 80/20 
and people may feel really well at first, but later the
tissue saturation drops and you never feel well again.  For 
most people the optimal percentage is the 98%/2%.  If you limit 
yourself to commercial preparations, there is too much T3.  
It's better to have compounded capsules with the proper amounts.


Chaithere:   Two part question on Synthroid.  How long is it 
safe to take?  I have been taking it for over 25 years, second, 
why do the bottles now come with a "take on empty stomach" label? 
I have been taking with breakfast for 25 years and habits 
are hard to break.  Thank you. 


Kenneth Blanchard, M.D.:   There is no limit on how long it is safe 
to take T4, if one is replacing what is lost in the body. Taking 
it on an empty stomach has been a common recommendation over the 
years.  All that does is increase the absorption
of T4.   If you wait an hour to eat, it might be an 80% 
absorption.  Work out a routine that works for you.  If you eat 
at the same time as the medications, it doesn't matter as long as 
you do it always at the same time and your body will 
adjust.  Keep it simple, routine and regular. 


Ricci:   Do you feel that hypothyroidism is hereditary? Thank 
you


Kenneth Blanchard, M.D.:   There is some degree of hereditary 
consideration. Certainly a strong family history can push
you towards a diagnosis.  I don't think it's that important,
but it can show a possibility of thyroidism.


KathyB48:   Are nosebleeds a symptom? Thanks. 


Kenneth Blanchard, M.D.:   No. 


Idelle:   Does the 98% T4 and 2% T3 generally give midrange 
free T4 and free T3 and non-suppressed TSH? If not, how 
would you adjust the dose?


Kenneth Blanchard, M.D.:   In general, it does give normal lab 
levels.  Anyone who is taking T3 has variable levels and I
think that the testing will change throughout 
the day.  For that reason free T3 levels aren't that good and 
the doctor should adjust the dose. 


Idelle:   Relative to when the T3 (and T4) are taken, when 
should free T4, freeT3, and TSH be tested?


Kenneth Blanchard, M.D.:   I don't make too much out of the timing 
of the testing but it is reasonable to not take the morning 
medications if the blood tests are in the morning.  There will 
be some suppression of TSH after taking the dose.  It's 
probably more trouble than it's worth if to take medications in 
the morning for a morning test, but ok for an afternoon test.  

MMM:   Bottom Line: What tests do I ask for to determine the 
extent of my hypothyroid? So far the only test I've been given 
is TSH and that has been inconclusive (normal).


Kenneth Blanchard, M.D.:   I think that some assessment of T4 
is warranted for any patient.  Most doctors believe that a free 
T4 is the second most important test.  Many doctors will test 
depending on the antibodies, even if the TSH is 
normal. I make my judgements based on total clinical picture, 
rather than any specific tests.  For 95% of my patients I make 
the assessment based on clinical presentation.  I don't believe 
that a doctor can make yes or no judgements based
on blood tests, other than grossly abnormal numbers.  The 
message of my book is that you can test normal and still have 
thyroid problems. 


WayBar:   Is there a relationship between progesterone and 
thyroid? My saliva tests show I'm low in progesterone, but 
I don't tolerate it well. I get very constipated. 
If I corrected the hypothyroidism, could I perhaps tolerate 
progesterone better? Thanks. 


Kenneth Blanchard, M.D.:   The connection between progesterone 
and thyroidis very indirect.  The book by 
Dr. John Lee, What Your Doctor May Not Tell You
About Menopause, raised the questions about progesterone 
and thyroid.  If you believe what he wrote, then giving a patient 
progesterone will help her thyroid.
I have tried this many times and have never been impressed with 
the results.I do still prescribe natural progesterone in skin
cream for women in their 40s and sometimes the cream will help, 
especially with bloating.


JanisWin:   I have had symptoms of hypothyroidism for years. I 
was diagnosed with panic disorder 10 years ago. I am 41 and haven't 
had a period in 6 months and my gynecologist says my FSH test
shows I'm in menopause. I had an ultrasound of my 
thyroid that showed several nodules around 6 cm. so my endo 
will not biopsy.

Can the nodules be causing my lack of period, anxiety (which is 
worse than ever since periods stopped) and I am so tired of 
feeling lousy. My endo says Synthroid will cause more panic 
attacks for me - is this true? I'm at a loss here. All my 
blood tests are always normal. Do you think the nodules can be 
causing my symptoms of hypothyroidism? 


Kenneth Blanchard, M.D.:   Well, it sounds like you need to be 
on thyroid. I doubt that T4 will increase panic attacks. If 
the test shows that you are in menopause, 
the doctor is referring to FSH.  This may not be related to 
hypothyroidism.  You should fix the thyroid, then see what 
else falls into place.  
You need clinical therapeutic medicine for thyroid.   
Nodules in the thyroid are very common and 
finding a nodule, to me, means nothing other than ruling out 
cancer.  An ultrasound is so sensitive that it could find 
nodules in most people in a supermarket line. The 
nodules mean that there is further evidence that you should 
have a therapeutic trial of medicine for thyroid.


Dearest:   As a last question, Landy asked: Have you heard 
of a connection between hypothyroidism and internal tremors/shaking?


Kenneth Blanchard, M.D.:   I'm not aware of any relationship.  
If someone has a tremor, it could get worse on thyroid medicine. 
I don't think that there's a simple relationship, though. 


Dearest:   Dr. Blanchard, thank you for a wonderfully 
informative and stimulating chat. I strongly recommend everyone 
read Dr. Ken Blanchard's new book,"What Your Doctor May Not 
Tell You About Hypothyroidism:A Simple Plan for Extraordinary 
Results".  

You can visit his Web site at:http://www.kblanchardmd.com. 
Also, read Dr. Blanchard's article, The Many Myths of 
Hypothyroidism


Kenneth Blanchard, M.D.:   I had a great time.  It was fun 
and makes me feel important! 


Dearest:  You ARE important! :) Thanks for coming tonight!






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